Retrieval of stuck burr by pullback orbital atherectomy with RESCUE technique: a case report

Background: Rotational atherectomy (RA) burr entrapment is an uncommon but potentially life-threatening complication. Additional percutaneous bailout is necessary when conventional percutaneous bailout strategies are unsuccessful in patients with prohibitive surgical risk. Case Summary: A 91-year-old man with a history of coronary artery bypass graft surgery presented with unstable angina caused by severely calcified diffuse stenosis of the right coronary artery. During lesion preparation, an RA burr became entrapped after crossing a heavily calcified segment. Multiple conventional percutaneous bailout techniques, including guide-extension catheter support, intravascular lithotripsy for the stuck site, snare retrieval, and repeat RA, failed to retrieve the stuck burr. Surgical extraction was considered extremely high risk because of advanced age and prior cardiac surgery. Intravascular ultrasound revealed that the burr was embedded within a calcified nodule along the inner curvature. Orbital atherectomy (OAS) was subsequently advanced beyond the stuck site, and a low-speed pullback manoeuver successfully freed the burr, allowing safe retrieval. Final angiography and intravascular imaging confirmed adequate plaque modification and favourable luminal enlargement without major complications. Discussion: The pullback OAS with the REtrieval of StuCk burr by pUllback orbital athErectomy (RESCUE) technique can be a rational bailout option when the stuck RA burr is located along the inner-curvature calcification. Intravascular imaging assessment is essential for selecting this treatment strategy.